For those of you reading this article who have also taken classes with me know that I am somewhat obsessed with treatment plans. I feel this is one of the keys to practice success, clinically and financially. Why is it relevant clinically and financially? Over treat your patients, and you earn that reputation in your community, so patients do not refer others. Under treat and your patients do not get better (especially functionally), they do not come back in the future, and they do not refer others. A line I have heard many times from young D.C.'s is: "The patient was 60% better after two visits." Without further care, the patient has no functional improvement, and who wants to be symptomatically 60% improved? Nobody! With 60% symptomatic improvement, that patient does not refer others and does not return to you in the future.
If you had cancer and went to an oncologist, you would expect a care plan. DC's sometimes say: "call me next week if you feel like you need another treatment." This does not work. That patient gets lost, and you never know what happened to them. You know when they should come back, the patient does not know.
Tell the patient what you think is right for them, and you will never feel like a salesperson. Here are three examples of new patients I saw recently.
Example 1: Acute low back and leg pain in a 64-year-old male with an initial diagnosis of the lumbar radiculopathy. Moderate DDD notes on x-rays along with significant abdominal aortic sclerosis with no dilation. I scheduled him 3 times/week for 3 weeks, and if no improvement, I will order a lumbar MRI. I will do manual care and a lot of anti-inflammatory supplements. He is very fit and should respond well to conservative care. I referred him to his cardiologist about the sclerosis in his aorta.
Example 2: 16-year-old female with 8 months of neck pain. She has had cervical x-rays and an MRI, both normal. She has had physical therapy, dry needling, massage, and drugs with no resolution. Upon my exam, the key findings include joint dysfunction and poor scapular stability. She is young, but this condition is chronic and resistant to improving. I will treat her 2 times/week for 4 weeks with adjustments and DNS based scapular stabilization.
Example 3: A 55-year-old healthy, athletic female came to me to evaluate her ongoing knee pain, post-surgical medial, and lateral meniscus repair. The surgeon also "cleaned up her arthritis." Often, this surgery does not go well for this age category. Her surgery was 8 months ago, and she is still significantly impaired. After my exam, we put together a care plan that included several things: continue the helpful rehab exercises, light knee brace with activity, but no running or jumping - and ice after activity, adjustments to areas of joint dysfunction in the locomotor chain and soft tissue work with me 1x/week for 8 weeks. Acupuncture has been somewhat helpful, so that she will continue that along with anti-inflammatory supplements. That is a lot of stuff, but she is not doing well despite lots of rest and rehabilitation. She wants and needs a care plan.
I never feel that I am selling a care plan. I simply tell them what is best for them. When I told the patients above the care plan, all three said the same thing, "Okay." They are looking for a game plan. Nothing wish-washy, the patients want a simple, straight forward game plan. Stay true to what you know is best for your patients, and you will build the practice of your dreams.
Mark A. King, D.C.
President - MPI
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written from both a clinical and business perspective to help you grow your skills and your practice!